A multicenter study led by Icahn School of Medicine at Mount Sinai researchers evaluated a novel electronic health record-based marker, the medication level variability index (MLVI), to identify pediatric liver transplant patients at risk for organ rejection due to medication nonadherence. The findings were published in the American Journal of Transplantation.
Key Details
- The study screened over 3,000 health records across 13 pediatric transplant centers in the US and Canada.
- 148 participants identified as high-risk by MLVI were randomized to standard care or a two-year remote behavioral intervention.
- The primary endpoint (composite of rejection, re-transplantation, and consent withdrawal) did not reach statistical significance, partly because rejection rates were lower than expected in both groups.
- Patients in the intervention group had approximately half as many rejection-related events and re-transplants compared to those receiving standard care.
- Routine use of MLVI across study sites was associated with reduced overall rejection rates to levels typical of low-risk patients.
Statements
Dr. Eyal Shemesh (Principal Investigator) stated that "MLVI allows clinicians to identify nonadherent patients using existing EHR data and intervene before rejection occurs."
Dr. Benjamin L. Shneider (Senior Author) noted that "the work demonstrates early recognition of nonadherence can prevent life-threatening consequences."
Dr. George Mazariegos (Author and Chair of Starzl Network) emphasized "the positive implications for optimizing life-long health."
Funding
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the NIH.